What Is Brain Inflammation?

Cerebral abscess refers to purulent encephalitis, chronic granulomas, and brain abscess capsule formation caused by pyogenic bacterial infections. A small part can also be caused by fungi and protozoa invading the brain tissue. Cerebral abscesses can occur at any age, with the most common among young adults, 14% under 11 years old, 67% 11 to 35 years old, 17% 36 to 55 years old, and 1% over 56 years old.

Causes of brain abscess

Brain abscesses are caused by bacterial infections, and are often divided into four categories according to the source of bacterial infections:

1. Brain abscess caused by the spread of adjacent infections

Otitis, mastoiditis, sinusitis, cranial osteomyelitis, and intracranial venous sinus infections can spread directly into the brain and form brain abscesses. Among them, brain abscesses caused by chronic otitis media and mastoiditis are the most common. They are called ear-derived brain abscesses, which account for about 50% to 66% of all brain abscesses. However, due to the timely treatment of many otitis media and mastoiditis in recent years, the proportion of ear-derived brain abscesses has decreased significantly. Otogenic brain abscesses are mostly brain abscesses due to chronic otitis media, mastoiditis, and acute onset of cholesteatoma. The infection pathways usually spread to the middle and posterior part of the intracranial temporal lobe through the tympanic cover or tympanic sinus, and account for about auristic brain abscess. 2/5. The other part of the dura mater is transmitted to the upper part of the cerebellum via the medial papillae, especially in children. The mastoid bone is thinner, and the infection tends to pass through the Trautman triangle (ie, the triangle formed below the petrosal sinus, above the facial nerve canal, and in front of the sigmoid sinus). Involves the cerebellum. However, the tympanic cavity and mastoid in children have not yet developed well, so pediatric ear abscesses are rare. Cerebellar abscesses account for about a third of otogenic brain abscesses. Ear-derived brain abscesses can also be retrogradely transferred to distant septum sites via the vein, such as the forehead, parietal occipital lobe, and even occasionally to the contralateral brain. Otogenic brain abscesses are mostly solitary. The common pathogenic bacteria are mainly Proteus and anaerobic bacteria. Streptococcus is the most common anaerobic bacteria, followed by bacilli and mixed infection.

Brain abscesses caused by sinusitis are called nasal-derived brain abscesses and are rare. Occurred at the bottom of the frontal lobe, mostly single, occasionally multiple. Mostly mixed infections. Brain abscesses caused by scalp rash, intracranial venous sinusitis, and cranial osteomyelitis all occur near the primary lesion. Brain abscesses and epidural, subdural or mixed abscesses can occur, and mixed infections It may also be a fungal infection.

2. Hematogenous brain abscess

It is mainly formed due to the introduction of inflammatory emboli from arterial infections from other parts of the distant body. It can also retrogradely pass through the thoracic, abdominal and pelvic organs such as the liver, gallbladder, submandibular, and urogenital system. Infection, the veins that coincide with the spinal canal in the valvular plexus around the spine enter the spinal canal and transfer to the skull. Intracranial infection may also develop from the return of infection in the triangular area of the face to the intracranial area. The source of infection is various purulent infections of the chest, such as pneumonia, pulmonary abscess, empyema, bronchiectasis and other brain abscesses, which are called thoracic brain abscesses; due to bacterial endocarditis, congenital heart disease, especially cyanosis Brain abscess caused by type heart disease is called cardiogenic brain abscess. Infants with congenital heart disease have cyanosis and often have erythrocytosis and hypercoagulable blood. Because the sick child has arteriovenous blood communication, peripheral venous blood can be directly transmitted into the brain to form an abscess once there is a purulent bacterial infection. Trans-arterial abscesses are usually located in the middle cerebral artery or the white matter and the cortex at the junction of the white matter and the cortex, so they are more common in the frontal, parietal, and temporal lobe. Infections on the face are more common in the frontal lobe. The pathogenic bacteria are mainly hemolytic Staphylococcus aureus, and the others are mostly mixed bacteria.

3. Traumatic brain abscess

Purulent bacteria are caused by external invasion into the brain. Debridement is incomplete and untimely. Foreign bodies or broken bone fragments remain in the brain, and abscesses can form within weeks. A few can form abscesses months or years or even decades after the injury. Generally, an abscess caused within 3 months is called an early abscess, and an advanced abscess is called after 3 months. Abscesses are mostly located at or near the trauma site, and the pathogenic bacteria are mostly Staphylococcus aureus or mixed bacteria.

4. Cryptogenic brain abscess

The cause is unknown, and the source of infection cannot be determined clinically. It is possible that both the primary infection and the secondary lesions in the brain are relatively mild or the body is resistant, and the inflammation is controlled and undetected, but the bacteria are still latent in the brain. Once the body's resistance decreases, the disease can begin. Therefore, such brain abscesses are essentially blood-borne brain abscesses, and the proportion of such brain abscesses in all brain abscesses is gradually increasing. Diagnosing before CT is difficult and often misdiagnosed.

In addition to bacterial infections, brain abscesses also include brain abscesses caused by fungi, protozoa, and parasites. In recent years, reports of brain abscesses due to impaired immune function have been increasing.

Cerebral abscess clinical manifestations

The clinical manifestations of brain abscesses can vary depending on the speed, size, location, and stage of pathological development of the abscess. Usually has the following four aspects.

1. Symptoms of acute infection and systemic poisoning

Most patients have a history of primary lesion infection. After different incubation periods, brain symptoms and systemic symptoms appear. Generally, the symptoms are acute, and fever, chills, headache, nausea, vomiting, fatigue, lethargy or restlessness, muscle soreness, etc., check for neck resistance, Kirschner sign Positive Brinell sign, increased peripheral blood, these symptoms can last for 1 to 2 weeks, but can also be as long as 2 to 3 months, the symptoms vary. After treatment with antibiotics, some patients can be cured, some infections become focalized, and the symptoms of systemic infection are gradually relieved, while the symptoms of localized localization and increased intracranial pressure are gradually apparent. If this group of symptoms is not obvious, it can be regarded as an incubation period, which can last for weeks or months, or even years.

2. Symptoms of increased intracranial pressure

Symptoms of increased intracranial pressure can occur during the acute encephalitis phase. With the formation and gradual increase of abscesses, the symptoms are further aggravated. Headache, vomiting, and optic disc edema are the three main symptoms. Headaches are mostly on the affected side, and suboccipital abscesses are mainly pain in the occipital and forehead, and involve neck pain. Most of the pain is persistent and paroxysmal, often worsening in the morning or during exertion. Vomiting can be jet, with cerebellar abscess headaches being more pronounced. When headaches get worse, vomiting gets worse. Inspection of the fundus may have different degrees of optic disc edema, severe retinal hemorrhage and exudation, and the incidence of optic disc edema can be as high as 50% to 80% before CT examination. With the improvement of examination methods and early diagnosis and early treatment, the proportion of optic disc edema has also decreased. Other patients still have compensatory slow pulse, elevated blood pressure, and slow breathing. Patients may also have different degrees of mental and conscious disturbances, such as indifferent expression, slow response, drowsiness, restlessness, etc. If coma occurs, it is already advanced.

3. Focal localization sign

Corresponding signs of nerve localization may occur according to the location, size, and nature of the abscess lesion. If the main hemisphere is involved, various aphasia can occur. If it involves the movement, sensory center and conduction beam, it produces different degrees of central hemiparesis and hemiplegia on the opposite side. It can also cause various seizures due to stimuli such as sports areas. Affecting the visual path may cause different degrees of ipsilateral contralateral blindness in both eyes. Frontal involvement often involves personality changes, mood and memory impairments. Cerebellar abscesses often have localized signs such as horizontal nystagmus, ataxia, forced head position, and positive Romberg sign. Brainstem abscesses can present complex signs specific to various brain nerve damage and long bundle signs. Rare pituitary abscess can appear changes such as hypopituitarism. In the temporal and frontal lobe of the non-dominant hemisphere, localized signs of abscess are not obvious.

4. Crisis

When the abscess develops to a certain degree, especially temporal lobe and cerebellar abscess are prone to cerebral hernia. Once a hernia occurs, it must be treated urgently. If not handled in a timely manner, it can be life threatening. Another crisis is the ulceration of the abscess. The ulcerated pus can enter the ventricle or subarachnoid space, forming acute suppurative ventriculitis and meningitis. Patients can have sudden high fever, coma, meningeal irritation or seizures, blood Routine examination of white blood cell count and neutrophil elevation, cerebrospinal fluid examination can be purulent cerebrospinal fluid, complicated and difficult to handle.

Brain abscess examination

Laboratory inspection

(1) After the formation of a pus cavity in the peripheral blood, the peripheral blood is usually normal or slightly elevated. 70% to 90% of patients with brain abscess have an accelerated red blood cell sedimentation rate. Increased C-reactive protein can be distinguished from brain tumors.

(2) Pus examination and bacterial culture The type of infection can be further understood through the examination and culture of pus. Drug sensitivity tests can guide the selection of antibiotics. Therefore, puncture pus or surgically remove the pus cavity, and promptly send it for inspection. The vessels used for anaerobic culture and inspection shall be sealed and isolated from the air for inspection. Bacterial smear staining and microscopy can also be done immediately, especially for those who have pus that has broken into the brain and ventricles, and cerebrospinal fluid is purulent. Microscopy can immediately understand the types of pathogenic bacteria to guide medication.

The type of bacteria can also be roughly judged according to the nature of pus. For example, the pus of Staphylococcus aureus is yellow and sticky, streptococcus is yellowish white and thin, Proteus is grayish white and thin with foul smell, E. coli is fecal-like foul smell, green Pseudomonas is a green fishy smell. Fungi are commonly found in cryptococcus and actinomycetes, and can be stained with Indian ink. Lung flukes are rice soup-like pus or cheese-like changes, with eggs in the pus. Amoebia pus is chocolate-colored, sticky and tasteless. Protozoan trophozoites can be found on the pus wall.

(3) Lumbar puncture and cerebrospinal fluid examination Through lumbar puncture, we can know whether there is an increase in intracranial pressure and the extent of the increase, but those who have a significant increase in intracranial pressure, especially in critical conditions, generally do not perform lumbar puncture. If inspection is needed, the operation must be very careful. After the puncture is successful, the manometer is quickly connected. After the pressure measurement, the fluid should be drained very slowly, leaving a small amount of cerebrospinal fluid for inspection. After the operation, the patient should lie supine for 6 hours and be given dehydration and hypotension. Cerebrospinal fluid examination may have increased white blood cells, generally at (50 to 100) × 10 ⁶ / L (50 to 100 / mm ³ ), the protein often rises, sugar and chloride changes little or slightly. Early cerebral abscesses or abscesses approach the brain surface or ventricle, and the cerebrospinal fluid changes significantly. If purulent changes occur, it indicates that the abscess is ulcerated.

2. Imaging examination

To further clarify the nature and location of brain abscesses and abscesses, auxiliary examinations are indispensable. With the development of diagnosis and treatment technology, the examination methods have been continuously updated, such as EEG, brain ultrasound examination, ventricular angiography, abscess angiography, cerebral angiography, radionuclide and so on. The diagnosis of brain abscesses has been rarely used, and currently mainly depends on CT scan or MRI scan, but lumbar puncture and skull X-ray film still have important diagnostic significance for the examination of some parts of the lesion.

(1) Plain radiographs such as otogenic abscesses can reveal bone destruction in the temporal bone rock, blurring or disappearing of the tympanic cap and mastoid atrium. Nasal brain abscesses may have poorly inflated or liquid-gas surfaces such as the frontal sinus, ethmoid sinus, and maxillary sinus, and even bone destruction. Traumatic brain abscess can find skull fracture fragments and intracranial metal foreign bodies. Skull osteomyelitis caused by brain abscess, can be found in the skull with osteomyelitis changes. In some cases, calcification of the abscess capsule can be seen. In children with chronic brain abscesses, there may be cracks in the skull bones, thinning of the bone plate, and occasional expansion of the sphenoid saddle in adults.

(2) Early diagnosis of brain abscess is difficult before the advent of cranial CT scan . Since the clinical application of CT examination, the diagnosis of brain abscess has become easy and accurate, and its mortality has also decreased significantly.

The CT manifestations of brain abscesses vary according to the stage of lesion development. In the acute encephalitis phase, the lesions showed a low-density area with blurred edges, which had a placeholder effect. The enhancement scan did not occur in the low-density area. In the initial stage after abscess formation, low-density space-occupying lesions are still present, but the enhanced scan may be slightly enhanced around the low-density, showing a complete irregular light circular enhancement. After the abscess wall is fully formed, its low-density edge density is high. A few can show the abscess wall. Enhanced scans show a complete, uniformly thick, ring-shaped enhancement, with obvious irregular brain edema and space occupying effects around it. The low-density area is necrosis. Brain tissue and pus, such as aerobic bacteria infection, can present gas and fluid levels, and if multifamily, one or more spaces can appear in low-density areas. According to clinical and experimental studies, the abscess ring sign shown on CT does not necessarily indicate the pathological abscess envelope. Studies have found that ring-shaped enhancement signs can appear after the third day of encephalitis, which is related to inflammation involving the blood-cerebrospinal fluid barrier, the formation of new blood vessels around inflammation, and the infiltration of inflammatory cells around blood vessels. It takes 10 to 14 days from the onset to the initial formation of the abscess, and it takes 6 weeks to fully mature. A small number of abscesses can also be confused with encephalitis. Therefore, the clinical diagnosis of brain abscesses cannot be based solely on CT. It also needs to be comprehensively considered in combination with medical history and other tests to make an accurate and objective diagnosis. Abscesses can be identified by CT scan in terms of location, size, morphology, single or multiple rooms, single or multiple, etc. CT scans are not only helpful for diagnosis, but also for choosing the timing of surgery and determining treatment options. Follow-up observation of the treatment effect.

(3) Craniocerebral MRI is another new examination method that appears after CT scan. According to the time of brain abscess formation, the performance is different. The acute encephalitis phase is characterized by long T1 and long T2 signal shadows with blurred borders in the brain, and there are placeholders. This period must be distinguished from gliomas and metastatic tumors. Contrast-enhanced scans can show the encephalitis phase earlier than CT scans. When the capsule is completely formed, T1 shows high signal shadows, and round dot-shaped vascular flow empty shadows can be seen in fashion. Gd-DTPA injection usually shows abnormal contrast enhancement within 5-15 minutes. Delayed scan enhancement can be further expanded outward, as the blood-cerebrospinal fluid barrier around the abscess is damaged.

Brain abscess diagnosis

According to medical history, clinical manifestations and necessary auxiliary examinations, comprehensive analysis can generally make a clear diagnosis, especially CT examinations play a decisive role. Because most brain abscesses are purulent lesions secondary to other parts of the body, patients often have chronic otitis media, acute mastoiditis, sinusitis, purulent infections of the chest and lungs, bacterial endocarditis, cyanosis A history of inflammatory diseases such as congenital heart disease, skin bloated and swollen, osteomyelitis, cranial osteomyelitis, sepsis and sepsis. Open craniocerebral trauma, especially in patients with bone fragments or foreign bodies remaining in the brain. After this period of incubation, the patient develops symptoms and signs of suppurative encephalitis. After treatment with antibiotics, the skull reappears. The signs of increased internal pressure and signs of localization, that is, the possibility of a brain abscess should be considered first, and further auxiliary examinations can mostly determine the location and qualitative diagnosis of the lesion.

Differential diagnosis of brain abscess

Brain abscesses should be distinguished from other intracranial infections and other intracranial space occupying lesions.

Purulent meningitis

Many cases have sharp onset, severe systemic symptoms of acute infection and meningeal irritation symptoms, focal signs of nervous system are not obvious, cerebrospinal fluid can be purulent, leukocyte increase is obvious, pus cells can be found. It is mainly distinguished from the brain abscess encephalitis phase, and some patients can hardly distinguish early. CT scan of the brain is helpful to identify.

2. Subdural and epidural abscesses

Both can be combined with brain abscesses, and the course is similar to brain abscesses. X-ray films of epidural abscesses can detect cranial osteomyelitis, which can be clearly diagnosed by CT scan or MRI scan.

3. Otogenic hydrocephalus

Chronic otitis media and mastoiditis caused by hydrocephalus due to transverse sinus embolism, clinical manifestations of headache, vomiting and other signs of increased intracranial pressure, but generally longer duration, mild systemic symptoms, no obvious signs of focal nervous system, A CT scan or MRI scan only shows some enlargement of the ventricles.

4. Intracranial sinus embolism

It is more common in sinus inflammatory embolism caused by chronic otitis media and mastoiditis. Systemic infection symptoms and increased intracranial pressure can occur, but there are no signs of focal nervous system. During lumbar puncture pressure measurement, the diseased side has no response during unilateral neck pressure test, which is helpful for diagnosis, but it should be performed carefully when the intracranial pressure is high. Can be identified by CT scan and MRI scan.

5. Purulent labyrinthitis

Clinical signs are cerebellar abscesses such as dizziness, vomiting, nystagmus, ataxia and forced head position. Unlike cerebellar abscesses, the headache is mild or absent. Elevated intracranial pressure and meningeal irritation were not obvious. CT scan and MRI scan were negative.

6. Tuberculous meningitis

Atypical tuberculous meningitis may have no obvious history of tuberculosis, tuberculosis focus and tuberculosis constitution. It needs to be distinguished from brain abscesses with a longer course and mild clinical symptoms. Cerebrospinal fluid examination is similar to brain abscesses, but lymphocytes and proteins are significantly increased, and Both sugar and chloride can be significantly reduced, and anti-TB treatment is effective. Both CT and MRI scans are helpful for identification.

7. Brain tumors

Some cryptogenic brain abscesses or chronic brain abscesses are not clinically obvious in terms of systemic infection symptoms and meningeal irritation, so it is not easy to distinguish them from brain tumors. Even the "ring sign" shown by CT scans is not unique to brain abscesses. It is also found in brain metastases, glioblastomas, and occasionally in chronic dilated brain hematomas. It can not be confirmed until surgery. Therefore, the medical history should be carefully analyzed, combined with various laboratory tests, and then with the help of various Contrast, CT and MRI scans were further identified.

Brain abscess treatment

The treatment of brain abscess should be based on the course of disease and different pathological stages, parts, single, multiple rooms or multiple, as well as the body's response and resistance, the type of pathogenic bacteria, virulence and drug resistance, the condition of the primary lesion, etc. Comprehensive analysis of factors to formulate a reasonable and effective treatment plan. The general treatment principle is: before the abscess has formed, comprehensive medical treatment should be the main treatment. Once an abscess has formed, surgery should be performed.

Drug treatment

Acute suppurative encephalitis and suppurative stage At this stage, it is mainly symptomatic treatment such as anti-infection and reducing intracranial pressure. Reasonable selection of antibiotics and application of dehydration drugs are supported by supportive therapy and symptomatic treatment. After a period of treatment, a few cases can be cured, most patients can be relieved of acute inflammation, the lesions can be quickly limited, and create good conditions for surgery, but a few severe patients have not yet formed an abscess, that is, a cerebral hernia, or even a cerebral hernia crisis. Elephants, emergency surgery should be taken to save lives.

(1) The selection of antibiotics should be based on the type of pathogenic bacteria, their sensitivity to bacteria, and the permeability of the drug to the blood-cerebrospinal fluid barrier. In principle, those that are sensitive to pathogenic bacteria should be selected to easily pass the blood-cerebrospinal fluid barrier. Before the bacteria are detected, a broad-spectrum antibiotic that can easily pass through the blood-cerebrospinal fluid barrier can be selected according to the condition. After the results of bacterial culture and drug sensitivity tests are obtained, they can be adjusted appropriately. Intravenous administration is generally used, and intrathecal, intraventricular, and pus injections can also be used depending on the condition.

(2) The application of dehydration drugs is mainly used to reduce intracranial pressure, alleviate the symptoms of increased intracranial pressure, and prevent the occurrence of cerebral hernia. Commonly used dehydration drugs include hypertonic dehydrating agents such as mannitol and glycerin solutions, and diuretic drugs such as furosemide (Fast urine), etaneric acid (sodium diurinate), etc., should pay attention to potassium supplementation, pay attention to renal function, acid-base and water-electrolyte balance check.

(3) Application of hormones While applying antibiotics, adrenocortical hormones can also be applied to improve and adjust the blood-cerebrospinal fluid barrier function, reduce capillary permeability, and reduce cerebral edema around brain abscesses. The commonly used hormone is dexamethasone, intravenous drip or intramuscular injection. Depending on the condition, you can increase the dose, pay attention to check blood sugar when taking the drug.

(4) Supportive therapy and symptomatic treatment mainly pay attention to nutrition and vitamin supplements, and pay attention to the adjustment of water, electrolyte and acid-base balance. Check liver and kidney function. Those with long disease course and poor general condition need proper transfusion of whole blood, plasma and protein to improve general condition, increase resistance, and create conditions for surgery. If there is high heat, you can physically cool down. For patients with concurrent epilepsy, antiepileptic drugs should be given, and other complications should be prevented and treated.

2. Surgical treatment

After the formation of the abscess capsule in the stage of brain abscess formation, surgical treatment should be performed as soon as possible while applying antibiotics, dehydration drugs, supportive therapy, etc. According to the type, location, disease, technology, and equipment of the abscess, comprehensive analysis , Choose the best treatment plan.

(1) Brain abscess puncture This method is simple, safe, and has little damage to brain tissues, and is especially suitable for the following situations: single abscesses in various parts; deeper abscesses or located in important functional parts such as speech center and motor center; Critical condition, especially those who have developed a hernia, need to quickly extract pus to relieve cerebral pressure; old and frail or suffer from other serious diseases at the same time, infants and young children and those who generally cannot tolerate craniotomy; Brain abscess caused by congenital heart disease; For patients with otitis media and mastoiditis, abscess puncture can be performed at the same time in patients with temporal lobe or cerebellar abscess; is not suitable for multiple or multilocular abscess or There are foreign bodies in the abscess cavity, but if necessary, multiple rooms and multiple abscesses can also be punctured with the help of CT and MRI scans under stereotactic guidance, and the effect is better when the positioning is accurate.

Cerebral abscess puncture and abscess: Select the abscess closest to the surface of the brain, but avoid functional areas. For otogenic temporal lobe abscess, the puncture point can be selected at the level of the ear and apex above the mastoid, which is equivalent to the posterior middle temporal gyrus. Routine disinfection, craniotomy, cross-cutting of the dura mater, selection of non-vascular areas, and protection of the surrounding cotton pads to prevent pus contamination. After electrocoagulation of the cerebral cortex, puncture directly into the pus cavity. A sense of elastic resistance, you can pierce the pus cavity wall into the pus cavity with a little force, pull out the needle core, immediately connect the prepared syringe, and slowly and as much as possible to pump the pus. The pus pumping process should avoid pus overflow and contaminate the surgery. wild. Record the amount, nature, color, and taste of the pus extracted, and make smears, and then send bacteria and anaerobic bacteria culture and drug sensitivity test. After the pus is drawn out, the cerebral cortex collapses and the brain pulse recovers. Rinse it repeatedly with an appropriate amount of physiological saline. Pay attention to the slow flushing of the injection, and do not inject too much each time, so as not to overflow due to excessive tension. Finally, an appropriate amount of antibiotics can be injected, and pus angiography can also be performed as a sign of re-puncture. If the pus cavity is close to the cerebral cortex, the injection should be careful to prevent antibiotics from overflowing into the subarachnoid space, which may cause seizures. If the puncture fails, reposition and correct the puncture.

Cerebellar abscess puncture and abscess: Make a longitudinal 3cm incision at the posterior edge of the mastoid or the midpoint perpendicular to the lateral midline, and drill the skull. The puncture direction should point to the outside of the cerebellum, with a depth of about 2 to 4 cm. Be careful not to puncture in the direction of the midline to avoid damaging the brain stem. It can also be combined with CT, scan or MRI scan to puncture, and the positioning is more accurate. The other steps are the same as for a brain abscess puncture.

(2) Rapid craniocerebral brain abscess puncture For rescue or emergency, it can be operated by the bedside. After positioning, quickly drill the skull directly. After the craniotomy is completed, the puncture needle punctures the abscess. After aspirating pus, other steps are the same as above.

(3) The continuous drainage of brain abscess catheter is generally used for single abscesses, thicker abscess walls, thick pus, formation of pus, and one-time abscess. In order to avoid repeated puncture after conventional or rapid craniotomy, a silicone catheter can be placed at the same time. If the pus is drained smoothly, the tube is fixed on the scalp, and the end is connected with an infusion bottle or infusion bag. The catheter is flushed with antibiotics every day and injected with antibiotics; if the pus is more difficult to drain, urokinase can be injected into the pus cavity, which has the effect of dissolving the pus to facilitate drainage. For deep abscesses such as the thalamus, functional areas, and brainstem, it is best to use CT or MRI to perform stereotactic puncture, which is more accurate. Various puncture and drainage methods must be closely observed for changes in the condition after the operation, such as increased intracranial pressure or localized signs of the patient, especially patients with altered consciousness, and CT scans for emergency conditions to understand the intracranial condition. If the scan is negative, especially if the patient has fever, a lumbar puncture should be performed to understand the brain pressure and send the cerebrospinal fluid for examination.

If the general drainage is smooth, inject antibiotics once a day after flushing, and review CT after 3 to 4 days. If the pus cavity has been reduced and the condition has improved, the antibiotic liquid can be prepared and continued to be washed once a day according to the drug sensitivity test. Generally, the washing solution can be removed after 5 to 6 days.

(4) Resection of brain abscess This operation can completely remove the lesion. Applicable to: the formation of the abscess capsule is intact, the location of the abscess is superficial, and it is not in the functional area; traumatic brain abscess, foreign bodies or fragments of bone in the abscess cavity, etc .; multilocular abscess and small abscess; the thickness of the abscess capsule , Those who have pus extraction or continuous drainage and the pus cavity does not disappear, or those who have drainage drainage, the effect is not obvious; recurrent brain abscess, usually need to be surgically removed, if the patient's condition is poor, you can puncture and pus first, wait After the condition is improved, surgical resection is performed; When the brain abscess ruptures in the ventricle or subarachnoid space, or acute cerebral hernia occurs, abscess resection should be performed in emergency cases and the overflowing pus should be flushed as much as possible; acute encephalitis or purulent period, Cerebral hernia caused by increased intracranial pressure, no matter whether the abscess capsule is formed or not, craniotomy must be performed urgently to remove inflammatory lesions and necrotic brain tissue and place drainage.

1) Antibiotics and dehydration drugs should be used before brain abscess resection . Locate the abscess, perform a bone flap or bone window craniotomy in the immediate vicinity of the abscess, and cut the dura mater. Check the cerebral cortex and pay attention to the selection of non-functional areas. In areas with no or less blood vessels, according to the size, depth, and increased intracranial pressure of the abscess, you can directly puncture and extract some of the pus to decompress to facilitate the free abscess wall, but pay attention to prevent the abscess. Liquid spills cause contamination and can be removed without puncture. In the vicinity of the abscess, cut the cerebral cortex deep into the wall of the abscess cavity, gradually separate from shallow to deep along the abscess capsule, and pad with cotton pads to protect the brain tissue. Finally, the abscess was lifted with toothless forceps, and the bottom was separated until it was completely removed. For temporal lobe-derived abscesses near the skull base, part of the envelope is often adhered to the meninges, and even a small part of the meninges is damaged. Particular care must be taken during separation to avoid contamination of the abscess. After the abscess is removed, the hemostasis is completely stopped, the abscess bed and the surgical field are flushed, and a drainage tube is placed. If the abscess is tightly adhered to important tissues or large blood vessels, if complete separation is difficult, you can keep this part, electrocoagulate the inner wall of the capsule, and carefully sterilize it locally; suture the dura mater and close the cranial cavity. If the brain hernia has been formed before surgery, the bone flap can be decompressed. If there is contamination during surgery, it can be carefully washed with hydrogen peroxide and antibiotic solution.

2) Cerebellar abscess resection. According to the location and size of the abscess, choose a midcranial or lateral midline incision of the posterior cranial fossa and cut the skin. The midmedian incision should be cut in layers along the midline white line and expose the first cervical posterior arch; Lateral midline incision. Pay attention to the great occipital nerve and blood vessels after subcutaneous incision. After electrocoagulation, cut the muscular layer to the periosteum. When separating the periosteum near the mastoid process, pay attention to the guide vein, which is easy to tear and bleeding. Electrocoagulation should be used to stop bleeding, and bone wax should be used to close the bone hole. Use the posterior fossa retractor to retract the incision, drill the craniotomy, and bite the skull to enlarge the bone window 5-6cm. The method and procedure of abscess removal are the same as those of brain abscess removal. Ear-derived cerebellar abscesses are the same as temporal lobe abscesses. Abdominal walls and some dura mates are also adhered to the upper corners of the abscesses. Pay attention when peeling. After the operation, the dura mater was not sutured, and the skull was sutured conventionally layer by layer, and a drainage tube was placed near the incision to drain the drainage tube.

(5) Open drainage or bag drainage is an ancient surgical method, which is rarely used now, but it can also be used in some cases: Superficial brain abscess caused by open craniocerebral trauma, especially with epidural abscess Or subdural abscess with cranial osteomyelitis or extracranial leakage of pus; ear surgery for ear abscess, mastoiditis or cholesteatoma, open surgery is possible; after craniotomy with various bone windows , The pus cavity is open, drainage is placed, and the medicine is changed regularly. This kind of surgery generally heals wounds slowly and takes a long time to treat.

Brain abscess complications

Complications include purulent encephalitis, ventriculitis, meningitis, subdural effusion, empyema, infectious intracranial venous sinus thrombosis, bacterial endocarditis, pneumonia, septic arthritis, sepsis, diffuse Intravascular coagulation (DIC) and multiple organ failure. Common sequelae are symptomatic epilepsy, hydrocephalus, and various neurological disorders, such as limb paralysis and aphasia.